To: General Managers, Planning & Funding

/ Insert DHB Logo

To: General Managers, Planning & Funding

Purpose: / National Services Business Case - major
Paper title:
Author/s:
Ministry of Health principal reviewer:
Date of meeting:
For your: / Discussion ( ) / Decision ( ) / Noting ( )
DHB Attendees to present to GMs: / (Please insert names and titles)
Presentation equipment required: / (Please advise equipment required)
Ministry review checklist (signature and clearly written name)
Pricing Programme / ___/___/___ extn:
Capital & Funding / ___/___/___ extn:
Office of the Chief Medical Officer / ___/___/___ extn:
Service Commissioning
Other / ___/___/___ extn:
Other People consulted
Name / Position / Business Unit / Extn
Presentation History
Version / Date/s previously presented / Reason rejected

National Service

Business Case

Major

[name of business case]

This business case sets out the justification for funding for more than $500,000 per annum:
One off / (select 1) / (insert estimated value)
Up to 3 years / (select 1) / (insert estimated value)
Ongoing / (select 1) / (insert estimated value)
Prepared by:
Prepared for:
Date:
Version:
Status:
DHB Sign Off (signature and clearly written name of those that have endorsed the business case)
Role / Name / Date / Contact
Service Manager / Delete if not applicable / ___/___/___
Clinical Director / Delete if not applicable / ___/___/___
Director, Planning & Funding / ___/___/___
Chief Operating Officer / ___/___/___
Chief Medical Office / Delete if not applicable / ___/___/___
Chief Financial Officer / ___/___/___
Chief Executive Officer / ___/___/___

Contents

Section 1: Document Control

Section 2: Summary

Section 3: Strategic Case (Case for Change)

Section 4: Financial Case

Section 5: Economic case (assessment of options)

Section 6: Risks

Section 7: Delivering the Change

Section 8: Appendices

Table 1: Cost of proposal

Table 2: Chase for change

Table 3: Revenue

Table 4: Cost gap assessment

Table 5: Options identification

Table 6: Options assessment

Table 7: Cost of preferred option

Table 8: Monetary benefits of preferred option

Table 9: Non-monetary benefits of preferred option

Table 10: Risks

Table 11: Implementation timeframe

Table 12: Stakeholders

Table 13: Communication approach

Section 1: Document Control

This document has been developed for consideration by the Ministry of Health and General Managers Planning & Funding, for a designated National Service.

Document History
Version / Issue date / Changes
Document Reviewed By:
Role / Name / Date / Contact
___/___/___
___/___/___
___/___/___
___/___/___
___/___/___
___/___/___
Supporting Documents (list any relevant)
Title / Author/s / Date of release / Document

Section 2: Summary

2.1 Key points

List the key points in the business case?

2.2 Executive summary

Provide a brief (1 page) summary of the key points, findings and recommendations

2.3 Background

Describe what you are requesting and why – what is the background that has led to the development of the business case?

What are the key links to patient/DHB/Triple Aim/Health Strategy goals?

2.4 Purpose

The purpose of this business case is to seek agreement for[describe here what you are requesting funding to support.

2.5How much will it cost?

The proposal is for a one off / two year / three year / ongoing(select one) investment. The annual estimated cost of this proposal is summarised below:

Table 1: Cost of proposal

Year / Amount / Description of services
Year 1
Year 2
Year 3
Total

Section 3: Strategic Case (Case for Change)

3.1 Goals

Discuss the overarching goals and/or health sector priorities that this business case will support – how does this link to DHB priorities and the New Zealand Health Strategy

3.2 Benefits

What are the key benefits that will be achieved for patients of the Service? How critical is this?How will you achieve and maintain equity of access?

3.3 Status Quo

What is the existing model of care, service model or arrangement? What opportunities to improve performance and get better value have already been implemented? What are the problems with maintaining the status quo?

3.4Service Needs

Provide a robust and compelling case for change that demonstrates:

The populations currently receiving the service, including levels of access and achieving or improving equity
a thorough understanding of the model of care the service is seeking to achieve
how this differs from the current model of care (existing arrangements)
the difference between the two, which represents the service gap (or service needs) that this proposal is intended to address. This gap analysis assists in providing a compelling case for change based on better outcomes for patients/service users.

Use data to support the current situation and the impact where appropriate, including a DHB population breakdown of the current state, levels of access and desired outcomes.

3.5 Case for Change

The case for change is summarised below.

Table 2: Chase for change

Investment Objective One / What you are seeking to achieve?
Existing Arrangements / Summarise the current state.
Business Needs / Describe the business gap, the difference between the current state and the desired future state.
Potential Scope / What degree of change is required to successfully achieve the objective? What is a core must have? What is desirable, aspirational or out of scope?
Potential Benefits / If the objective is successfully achieved, who will benefit, how and how we measure the gain (or loss)?
Potential Risks / What contingent events could impact on the achievement of the objective?
Constraints and Dependencies / What are the limiting parameters within which the investment must be delivered? What other actions outside the scope does success depend on?

3.6 Measuring Success

The overall outcomes supported by the proposal are[your text goes here]

Describe the baseline performance in these measures, and the level of improvement projected – include data/graphs

3.7 Collaboration and consultation

How does this proposal relate to other projects or programmes that are in place or being developed?

How might this proposal impact on other DHB services, including requirements for changing models of care for these patients, different provision of support services, different technology impacts

What consideration has been given to collaborative or shared care models with other DHBs, particularly in outreach situations. Summarise why these are/are not being pursued.

What are the longer term plans for the service? Is there opportunity for the model of care be localised at some point in the future, providing care for patients closer to home?

What consultation has occurred with interested stakeholders in developing this proposal.

Section 4: Financial Case

4.1 Revenue

Describe the financial situation, including all current sources of revenue received to provide the service, how the revenue is used/distributed and factors influencing access to revenue.

Describe the actual funding allocated to the DHB for the Service

Table 3: Revenue

Funding type / Year before last / Last year actual / This year planned / Next year planned
Top slice
Programme fee
DRG
Tertiary Adjustor
Non DRG
ACC
Other
Total Revenue

4.2Service Cost Gap Assessment

Describe the factors impacting on the cost of providing the service, including fixed and variable costs. Insert additional rows into the table, or attach relevant spreadsheets or data if required.

Where costs have exceeded revenue, describe actions taken to manage or reduce costs.

Table 4: Cost gap assessment

Funding type / Year before last / Last year actual / This year planned / Next year planned
Total Service Revenue
Direct costs (minus margin)
Overhead
Total Service Costs
Variation

4.3Financial Justification

Describe why the service needs or proposal cannot be managed within existing funding, including steps taken to achieve greater efficiency or reduce costs.

Section 5: Economic case (assessment of options)

5.1Options identification

Describe the steps taken to develop a range of options and prioritise these for consideration. Describe the how the options will/will not address the service needs and realise the benefits. Classify options according to the following

Table 5: Options identification

Dimension / Description / Options within each dimension
Scale, scope and location / In relation to the proposal, what levels of coverage are possible and how will equity of access be managed?
Service solution / How can services be provided?
Service delivery / Who can deliver the services?
Implementation / When can services be delivered?
Funding / How can it be funded?

5.2Options assessment

On the basis of the initial assessment of the long-list options (by dimension), the following short-listed options were selected for further economic analysis.

Table 6: Options assessment

Option 1: Name (status quo)
Description
Advantages
Disadvantages
Conclusion
Option 2: Name (preferred)
Description
Advantages
Disadvantages
Conclusion
Option 3: Name
Description
Advantages
Disadvantages
Conclusion
Option 4: Name
Description
Advantages
Disadvantages
Conclusion

5.3The Preferred Option

Each option has been assessed and the economic case is outlined in the tables7-9 below. The options analysis uses the following assumptions:

Describe assumptions

The preferred option is (name option) because(describe why preferred over other options)

5.4Costs of the Preferred Option

Provide a breakdown of costs of the Preferred Option in Table 7. Describe the justification for these costs and any factors influencing costs in any area.

Table 7: Cost of preferred option

Year 1 / Year 1 / Year 3 / Out years
Capital Costs
Personnel Costs
Other Costs
Total Costs

5.5Monetary benefits of the Preferred Option

Describe any monetary benefits from the proposal/investment in the table below, how these were assessed and any assumptions that apply

Table 8: Monetary benefits of preferred option

Monetary Benefits / Estimates and Timing / Description

5.6Non-Monetary benefits of Preferred Option

Describe any non-monetary benefits from the proposal/investment in the table below. Describe how non-monetary benefits were assessed, and any assumptions that apply.

Table 9: Non-monetary benefits of preferred option

Non-monetary Benefits / Description

Section 6: Risks

6.1 Proposal risks

Describe any risks associated with the proposal, including operational, implementation and other risks, and any mitigations.

Table 10: Risks

Risk description / Rating / How risk will be managed

6.2 What risks will the proposal mitigate?

The proposal will mitigate the risk of [describe the consequence of doing nothing]Consider what this may mean for current patients of the Service, and potential new patients.

Section 7: Delivering the Change

7.1 Implementation

Describe the intended implementation or change process that is expected if the proposal is accepted.

Consider and describe the following:

reporting and monitoring changes and how performance, including activity, quality and equity, will be monitored
recruitment requirements, steps and anticipated timeframes – describe contingencies if recruitment is not successful
internal DHB changes required to achieve the described outcomes
how changes will be communicated to referrers
how changes in provision of outreach services (if applicable) will be managed

Include a description of the anticipated timeline for completing the implementation, and achieving improvement.

Table 11: Implementation timeframe

High-Level Milestone or Deliverable / Target Date

7.2 Stakeholder engagement

Describe stakeholders critical to implementation of the proposal, their relationship and the planned engagement approach.

Table 12: Stakeholders

Stakeholder / Relationship to Project / Engagement Approach
Person or group / They’re the intended end-users
They’ll be an interested party because
They’ll be an affected party because
Their support is crucial to

7.3 Communication approach

Describe the intended implementation or change process that is expected if the proposal is accepted.

Table 13: Communication approach

Audience / Communication outcomes / Approach
Email
Written communication
Meetings
Workshops

7.4 Progress reports

Describe how you will report back to the NHB and Funders on:

the status of the change programme
how you will measure and report on levels of patient activity and access by domicile
identified measures of success (as identified in section 3.6)
achievement of non monetary benefits (as identified in section 5.6)
realisation of monetary benefits (as identified in section 5.6).

Section 8: Appendices

Supporting Documents (list any relevant)
Title / Author/s / Date of release / Document

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